Diagnosis and treatment directions and research frontiers of systemic lupus erythematosus

Abstract: Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multi-system involvement and multiple autoantibodies. It mainly occurs in women of childbearing age. Genome-wide association study, metagenomics, epigenetics, single-cell sequencing, immunometabolic study, and multi-omics study are playing an increasingly important role in the pathogenesis research of SLE. Autoantibodies are critical in the diagnosis and disease monitoring of SLE. The 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria and the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria are most commonly used criteria in clinical research and practice. Early diagnosis and early treatment of SLE are the principles that should be followed to promptly control the disease, prevent organ damage accrual, improve long-term quality of life, and prolong survival. The “treat-to-target (T2T)” concept will help improve the treatment of SLE. However, due to the great heterogeneity of the disease, treatment should be individualized under the premise of following the T2T concept. In addition to commonly used medications for SLE such as glucocorticoids, antimalarials, and immunosuppressants, biologic agents targeting B cells provide new therapeutic choices, and will become a future direction of SLE treatment. Stem cell therapy also has a good application prospect. With the improvement of SLE prognosis, rheumatologists are paying more attention to perinatal management and prevention of early atherosclerosis. This paper reviews the diagnosis and treatment directions and research frontiers of SLE in recent years to provide reference for rheumatologists and researchers.